Science or Quackery?
A campaign by five families reignites the debate over the chiropractic industry
May 22, 2004
Twenty-year-old Laurie Jean Mathiason died a violent, horrible death. An autopsy found she had a traumatic rupture of the left vertebral artery; it was not only just torn on the inside lining, it was punctured through.
When the tearing occurred, blood spilled into the cavity of her brain, creating such intense pressure in her skull, brain tissue was squeezed down to the bottom of her spinal cord. She was declared brain dead within 24 hours.
What caused this trauma?
Chiropractic neck manipulation gone wrong.
On April 30, the families of Mathiason, Lana Dale Lewis, Donna Claire Fawcett, Renate Dora Labonte and Dr. Ron Grainger -- all dead as a consequence of similar neck treatments for minor ailments -- sent a booklet and videotape to 400 politicians, with an appeal for an immediate moratorium on chiropractic adjustments that involve the top two vertebrae of the neck. It is a request that deserves a serious hearing.
This group does not want to stop chiropractic treatment on the lower neck, lower back or any of the other safer services offered by chiropractors. They do not want to stop funding chiropractic services.
They want provincial health ministers to take three months to investigate whether there is any medical merit to the practice of cracking the neck to treat illness, and whether the benefits of such a practice outweigh the risks.
After watching the home video made by the families of these victims (and others who have suffered stroke, paralysis and quadriplegia), one requires no expertise in chiropractics to see it is not only a reasonable request, but an urgent one.
The purpose of chiropractic treatment is to detect and correct spinal misalignments (called subluxations) which, it is thought, can irritate the nerves and interfere with proper energy flow. Once vertebrae are brought back into alignment, energy flow is restored, allowing the body to heal itself.
So, upper neck manipulation does not just benefit patients with neck pain, headaches and whiplash, it can also be used to treat, well, almost everything.
A binder full of chiropractic brochures contains remarkable claims: neck and back manipulation can treat gall stones, arthritis, heart trouble, eye trouble, constipation, colds, tonsillitis, appendicitis, cirrhosis, diabetes -- the list is endless.
The brochure for treatment of diabetes states: "with normal vertebral alignment re-established, the nerve supply can again freely reach the affected area, permitting the body to maintain normal metabolism."
The family-produced video includes footage which shows a baby getting its neck cracked, as an alternative to immunization. Brochures advertise the treatment of childhood fevers, asthma, allergies, colic, bedwetting, ADHD, and learning disabilities.
What politicians need to ask is, how widespread are these treatments and where's the proof any of it works?
In a 2001 paper, three professors of chiropractic condemned the largest professional associations in the U.S. and Canada for producing and distributing these pamphlets, saying they "make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or that are intrinsically untestable."
Yet it continues. One Calgary area chiropractor was advertising last year to draw patients in for an adjustment to protect against West Nile virus and SARS. That is not medicine, nor is it sound science.
Why aren't regulatory agencies doing something about it?
In conventional medicine, a pharmaceutical company can't get a product on the shelf until it's gone through four stages of testing. If any consumer product were sold based on exaggerated promises, it would be penalized by regulators, forced to publicly retract its claims and refund customers' money. If the consequences were benign, perhaps there would be little reason to pursue it. In some cases, it appears the consequences are anything but benign.
The chiropractors point to a 2002 article in the Annals of Internal Medicine, a journal of the American College of Physicians, to support their claim that neck manipulation is safe.
It states, "The apparent rarity of these accidental events has made it difficult to assess the magnitude of the complication risk."
The article was written by chiropractors and is -- in the words of medical doctor and chiropractic critic Stephen Barrett -- "a one-sided puff piece" in which they "either ignore or attempt to obfuscate information about chiropractic's shortcomings."
Further, on its website, the College of Chiropractors of Alberta points to research by Walter Herzog, associate dean of research, faculty of kinesiology, at the University of Calgary.
His study concludes neck adjustment is done well within the normal range of motion, that no force is applied to the arteries during an adjustment, and that arteries are not stretched -- rendering unlikely that damage would occur to vertebral arteries during neck adjustment.
Herzog's critics say his research is not reliable because it was conducted on cadavers, (five dead people aged 80 to 99), he placed the devices measuring the pressure in the wrong place on the artery, and that pressure isn't the main issue anyway -- the strokes that are resulting in death and disability are typically caused by blood clotting from damage to the interior of the artery.
All Herzog proved was that dead people can't have strokes.
Meanwhile there are 60 academic studies, published in peer-reviewed journals, that link chiropractic neck manipulation to incidents of stroke.
Barrett contends the chiropractic profession "has not made a serious effort to study the incidence" of complications resulting from neck adjustment.
For instance, an article from the October 2001 Canadian Medical Association Journal calculates a rate of one in eight million office visits, based on a study of malpractice data. But it's not remotely accurate.
The equivalent would be like trying to calculate the number of auto injury accidents based solely on the cases that make it to court.
In a January 2002 article for the Canadian Medical Association Journal, professor Edward Ernst writes there is "convincing evidence" spinal manipulation has "frequent, mild adverse effects as well as serious complications of unknown incidence."
At least one study estimates the risk of complication as high as 1 in 5,000.
Is further investigation not warranted?
In the 2002-03 fiscal year, Alberta taxpayers forked over $38.5 million to Alberta's 745 chiropractors, an average billing of $51,725 each. Alberta Health pays $12.66 per visit per patient, to an annual maximum of $200.
If the incidence of permanent disability is as high as one in 5,000, that would mean that since there were 3,043,585 treatments performed last year, 609 people are dead, paralysed or suffering the after-effects of stroke -- all paid for by the health-care system, and all as a consequence of treatment for minor maladies such as back pain, headaches and sinus congestion.
Is it really worth the risk?
Our politicians need to find out.
In its most recent budget, the Liberal government of Ontario de-insured chiropractic care, which will save Ontario taxpayers more than $100 million a year. It's time the Alberta government struck a committee to gain more knowledge into the risks of chiropractic and consider whether public funding should continue.
© The Calgary Herald 2004
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